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Analytical summary - Neglected tropical diseases

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Despite Namibia having reached the leprosy elimination target of less than one case per 10,000 inhabitants nationally, there are still pockets of the disease, particularly in Caprivi and Kavango regions. Following a WHO-supported assessment in 2009, four new cases were identified, adding to the 22 cases reported in 2007 and 2008. Training workshops and a review meeting were conducted to target Kavango and Caprivi. (MoHSS, NTLP Annual Report 2010) There is no data on the disease burden of other neglected tropical diseases in Namibia.

Schistosomiasis and soil-transmitted helminthesHelminths poses a serious health problem in the northern regions particularly in Caprivi, Kavango and Omusati regions. It is likely that 14% of the population are infected, with many more at risk of infection. According to the study done in the affected regions in 2000 and 2001, the prevalence of schistosomiasis in Namibia ranges from 17% - 100% in Kavango, 0% -54% in Caprivi and Omusati regions.

The rates of anaemia among pregnant women are highest in these regions where soiltransmittedsoil transmitted helminthesHelminths and schistosomiasis are endemic. These areas are also associated with the highest rates of growth retardation among children. The school population also suffers from worm and other parasitic diseases such as schistosomiasis. These results warrant attention as a public health problem. (MoHSS, July 2010)

Plague was successfully controlled and eliminated in Namibia following the establishment of a plague control programme in 1999. Prior to this, cases of plague were reported in Ohangwena region and in Oshikoto region (Onandjokwe district). The programme strategies included strengthening management capability at the local level, case recognition and management, dusting programme, rodent trapping programme, health education and plague surveillance system. Plague cases were reduced from 1,092 to zero within 3 years and deaths from 45 to zero within 2 years.

The case fatality rate was reduced from 4.12% to 0% over a 3-year period. No cases have been reported in Namibia since 2003. Although plague has been successfully eliminated in the affected areas, re-emergence cannot be excluded and therefore there is a need to strengthen surveillance and active case detection. (MoHSS, July 2010)

Human African trypanosomiasis (sleeping sickness) has not been present in Namibia for decades. (WHO, July 2007) According to CDC, guinea worm disease, lymphatic filariasis, onchocerciasis and trachoma are not present in Namibia, but schistosomiasis and soil-transmitted helminths are. (CDC)

WHO identified over 200,000 pre-school age children and over 500,000 school age children for preventive chemotherapy in 2008, 2009 and 2010, but there has been no coverage in these years . (WHO)

In 2006-07, only 9.1% of children between 6 and 59 months had received deworming medication for helminthesHelminths and schistosomiasis in the last six months and only seven percent of women with a child born in the past five years took deworming medication during pregnancy for the last birth. (MoHSS and Macro, August 2008)

Guinea worm disease, human African trypanosomiasis, leishmaniasis, leprosy, onchocerciasis, schistosomiasis and trachoma are referenced in the new IDSR guidelines, which are currently under review. Leishmaniasis and helminths are referenced in the WHO HIV clinical staging guidelines (WHO, 2007) and chlamydia trachomatis (the cause of trachoma) is referenced in the MoHSS STI Guidelines (MoHSS, 2009).

Deworming for helminthesHelminths and schistosomiasis among children (6-59 months) and pregnant women is included in the demographic and health surveys for Namibia. To improve the focus on the management of leprosy, a new position of Leprosy Coordinator will be created at national level. The Second Medium Term Strategic Plan for Tuberculosis and Leprosy 2010-2015 comprises four strategic results focussing on leprosy and the goal of eradicating leprosy by 2015.

The National Tuberculosis and Leprosy Programme (NTLP) in directorate Special Programmes (DSP) also receivesreceive free (MDT) for the treatment of leprosy via WHO. (MoHSS, NTLP Annual Report 2010) There will be deliberate national surveillance efforts to validate the current status of leprosy elimination in Namibia. (MoHSS, NTLP SP 2010)

Bibliography CDC. (n.d.). Neglected Tropical Diseases. Retrieved November 2011, from CDC: MoHSS and Macro. (August 2008). Namibia Demographic and Health Survey 2006-07. Windhoek, Namibia and Calverton, Maryland, USA: MoHSS and Macro. MoHSS. (2009). Guidelines for the Management of Sexually Transmitted Infections using the Syndromic Approach, 2nd Edition. Windhoek: MoHSS. MoHSS. (NTLP Annual Report 2010). National Tuberculosis and Leprosy Programme Annual Report: 2009-2010. Whk: Republic of Namibia. MoHSS. (NTLP SP 2010). National Tuberculosis and Leprosy Programme Second Medium Term Strategic Plan for Tuberculosis and Leprosy 2010-2015. Windhoek: Republic of Namibia. WHO. (July 2007). ANNUAL REPORT 2006: Neglected Tropical Diseases. Geneva: WHO. WHO. (n.d.). PCT Databank WHO. Retrieved November 2011, from WHO: WHO. (2007). WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Retrieved November 2011, from WHO:

CDC CentersCentres for Disease Control and Prevention DSP directorate Special Programmes HIV Human Immunodeficiency Virus IDSR Integrated Disease Surveillance and Response MDT Multi-drug therapy MoHSS Ministry of Health and Social Services NDHS National Demographic and Health Survey NTLP National Tuberculosis and Leprosy Programme WHO World Health Organization